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This is VAERS ID 991622

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 991622
VAERS Form:2
Age:90.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-01-28
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 81 mg Aspirin Prevident 5000 Pepcid 20 mg Propafenone 150 mg Biscodyl Suppository Milk of Magnesia Acetaminophen 325 mg Miralax Powder Ferrous Sulfate 325 mg
Current Illness: Cerebral Infarction due to embolism Crohn''s Disease Gastric Reflux Hyperlipidemia HTN SENILE DEGENERATION OF BRAIN, NOT ELSEWHERE CLASSIFIED PRIMARY GENERALIZED (OSTEO)ARTHRITIS
Preexisting Conditions: See Item 11
Allergies: Adhesive Tape (intolerance) Procaine (intolerance)
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Death

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